C-reactive protein in degenerative aortic valve stenosis

Degenerative aortic valve stenosis includes a range of disorder severity from mild leaflet thickening without valve obstruction, "aortic sclerosis", to severe calcified aortic stenosis. It is a slowly progressive active process of valve modification similar to atherosclerosis for cardiovascular risk factors, lipoprotein deposition, chronic inflammation, and calcification. Systemic signs of inflammation, as wall and serum C-reactive protein, similar to those found in atherosclerosis, are present in patients with degenerative aortic valve stenosis and may be expression of a common disease, useful in monitoring of stenosis progression

C-reactive protein in aortic valve disease

Aortic Valve Disease, includes a range of disorder severity from mild leaflet thickening without valve obstruction, "aortic sclerosis", to severe calcified aortic stenosis. It is a slowly progressive active process of valve modification similar atherosclerosis for cardiovascular risk factors, lipoprotein deposition, chronic inflammation, and calcification. Systemic signs of inflammation, as wall and serum CRP, similar to those found in atherosclerosis, are present in patients with degenerative aortic valve stenosis and may be expression of a common disease, useful in monitoring of stenosis progression

TAVI nel trattamento della stenosi aortica degenerativa: stato dell’arte e prospettive

Degenerative aortic stenosis is the most common form of heart valve disease in developed countries and predominantly affects the elderly. Aortic valve replacement (AVR) has been the gold standard, but recently, transcatheter aortic valve implantation has emerged as an effective therapeutic alternative to conventional AVR for high-risk patients. This review analyzed the literature about AVR, with the objective of evaluating the outcomes of transcatheter aortic valve implantation in patients who are not eligible for surgery showing an improvement in quality of life and middle-term outcomes. The crucial point is the lack of studies with long-term follow-up that could give therapeutic importance to percutaneous valve replacemen

Retrospective study of the association between neutering status and changes secondary to degenerative mitral valve disease

Dissertação de Mestrado Integrado em Medicina VeterináriaMyxomatous mitral valve disease is the most common cardiovascular disease reported in dogs. Although many patients may remain asymptomatic, some of them progress to left-sided congestive heart failure and develop clinical signs. Little has yet been published regarding the possible influence of the neutering status on changes secondary to myxomatous mitral valve disease. This study aims to assess a possible correlation between neutering status and myxomatous mitral valve disease. A retrospective study was conducted and included all the cases diagnosed with myxomatous mitral valve disease, consulted at the Cardiology service of the University of Liverpool. To help assess the association between neutering status and cardiac remodelling, dogs were categorized into four groups: FE (female entire), FN (female neutered), ME (male entire) and MN (male neutered). Retrospective review of echocardiographic data, signalment, and underlying diseases were performed. Echocardiographic measurements were made through offline analysis. Echocardiographic measurements were then compared between groups. Five hundred and eighty-two dogs (n = 582) were included: female entire (n = 24), female neutered (n = 235), male entire (n = 115) and male neutered (n = 208). Left ventricular internal diameter at end diastole (LVIDd), left atrial dimension to the aortic root diameter (LA:Ao) and left atrium maximal dimension to the aortic root dimension (LAmax:Ao) were significantly different between ME and MN, with ME dogs presenting higher mean values for LVIDd and higher median LA:Ao and LAmax:Ao measurements. Left ventricular internal diameter at end systole (LVIDs) was not significantly different between ME and MN. There were no significant differences between FE and FN groups. This study shows that neutering status may influence the development of myxomatous mitral valve disease in male dogs and that entire male dogs could be at higher risk of developing cardiac remodelling secondary to myxomatous mitral valve disease. On the other hand, neutering status doesn’t seem to have an influence on disease progression in female dogs.RESUMO - Estudo retrospetivo da associação entre a esterilização e alterações secundárias à doença mixomatosa da válvula mitral - A doença mixomatosa da válvula mitral é a doença cardiovascular mais prevalente em cães. Apesar da maior parte dos pacientes permanecerem assintomáticos, alguns podem progredir para insuficiência cardíaca esquerda e desenvolver sinais clínicos. Até hoje, existem poucas publicações sobre o possível efeito que a esterilização possa ter no desenvolvimento da doença mixomatosa da válvula mitral. O objetivo deste estudo é avaliar se existe de facto uma relação entre a esterilização e a doença mixomatosa da válvula mitral. Foi realizado um estudo retrospetivo que incluiu todos os casos diagnosticados com doença mixomatosa da válvula mitral consultados no serviço de Cardiologia da Universidade de Liverpool. Para avaliar a relação entre a esterilização e a presença de remodelação cardíaca, os cães foram categorizados em quatro grupos: FE (fêmeas inteiras), FN (fêmeas esterilizadas), ME (machos inteiros) e MN (machos castrados). A história pregressa e os dados ecocardiográficos dos animais foram revistos retrospetivamente e as medidas ecocardiográficas foram obtidas por medição offline. Estas medições foram depois comparadas entre os diferentes grupos. Quinhentos e oitenta e dois cães (n = 582) foram incluídos: fêmeas inteiras (n = 24), fêmeas esterilizadas (n = 235), machos inteiros (n = 115) e machos castrados (n = 208). Nos resultados obtidos, o diâmetro interno do ventrículo esquerdo no final da diástole (LVIDd), o rácio átrio esquerdo-aorta (LA:Ao) e o rácio diâmetro máximo do átrio esquerdo-aorta (LAmax:Ao) foram estatisticamente significativos entre machos inteiros e machos castrados. Os machos inteiros apresentaram não só um LVIDd médio superior, como também uma mediana de LA:Ao e LAmax:Ao superior aos machos castrados. Ao mesmo tempo, o diâmetro interno do ventrículo esquerdo no final da sístole (LVIDs) não mostrou ser estatisticamente significativo entre machos inteiros e machos castrados e nenhum dos parâmetros ecocardiográficos anteriormente referidos revelou ser estatisticamente significativo entre fêmeas inteiras e fêmeas esterilizadas. Este estudo demonstra que a esterilização poderá influenciar o desenvolvimento da doença mixomatosa da válvula mitral e que os cães machos inteiros poderão apresentar um maior risco de desenvolver remodelação cardíaca secundária a esta doença. No entanto, a esterilização não aparenta influenciar a progressão desta doença em cadelas.N/

Spontaneous Degenerative Aortic Valve Disease in New Zealand Obese Mice

Background: Degenerative aortic valve (AoV) disease and resulting aortic stenosis are major clinical health problems. Murine models of valve disease are rare, resulting in a translational knowledge gap on underlying mechanisms, functional consequences, and potential therapies. Naive New Zealand obese (NZO) mice were recently found to have a dramatic decline of left ventricular (LV) function at early age. Therefore, we aimed to identify the underlying cause of reduced LV function in NZO mice. Methods and Results: Cardiac function and pulmonary hemodynamics of NZO and age-matched C57BL/6J mice were monitored by serial echocardiographic examinations. AoVs in NZO mice demonstrated extensive thickening, asymmetric aortic leaflet formation, and cartilaginous transformation of the valvular stroma. Doppler echocardiography of the aorta revealed increased peak velocity profiles, holodiastolic flow reversal, and dilatation of the ascending aorta, consistent with aortic stenosis and regurgitation. Compensated LV hypertrophy deteriorated to decompensated LV failure and remodeling, as indicated by increased LV mass, interstitial fibrosis, and inflammatory cell infiltration. Elevated LV pressures in NZO mice were associated with lung congestion and cor pulmonale, evident as right ventricular dilatation, decreased right ventricular function, and increased mean right ventricular systolic pressure, indicative for the development of pulmonary hypertension and ultimately right ventricular failure. Conclusions: NZO mice demonstrate as a novel murine model to spontaneously develop degenerative AoV disease, aortic stenosis, and the associated end organ damages of both ventricles and the lung. Closely mimicking the clinical scenario of degenerative AoV disease, the model may facilitate a better mechanistic understanding and testing of novel treatment strategies in degenerative AoV disease

The Effects of Smoking on the Calcification of the Aortic Valve

Calcific Aortic Valve Disease is responsible for approximately 28,000 deaths annually and the complete mechanism is not completely understood. The disease is known to be effected by an inflammatory response, osteogenic response and an oxidative stress response that leads to thickening and mineralization of the aortic valve. Originally, this disease was thought to be brought on by age and deterioration of the valve but these rapid stress responses when the valve is disrupted by biochemical and mechanical stress has led to its classification as an active disease. Smoking has been shown to have many of the same effects experienced by CAVD but whether the two are directly connected as not been determined. The focus of this Honors project is thus to identify if smoking will elicit a pathological response in vitro to better understand the pathways induced and to identify ways to mitigate smoking-related valve disease. It is hypothesized that cigarette smoke will lead to an inflammatory response, osteogenic-like response, and oxidative stress by analyzing the changes in TGF-B1, IL-6, osteopontin, osteocalcin, RUNX2, and LOX-1. To achieve this, VICs were subjected to 1% and 0.5% Marlboro Red and Silver cigarettes for 6, 24, and 48 hours and were analyzed via RT-PCR and Western Blot. This study concluded that smoking results in the upregulation of IL6 when examined with RT- PCR and the presence of LOX-1 when examined by Western Blot. The presence of these two factors proves that there was an increase of oxidized LDLs as is characteristic of oxidative stress. These results, in combination with the fact that osteopontin, osteocalcin, and RUNX2 gene expression were upregulated at the 6 hour and 48- hour time points, also suggest that there is still a possibility that smoking could induce an osteogenic response if the VICs were subjected to the smoking extracts for longer time periods. The degree to which smoking induces an inflammatory response and an osteogenic response will have to be further tested

Clinical case of acute chord rupture of the mitral valve posterior leaflet in older patient with comorbidities

The article describes the etiologic role of various factors such as chronic rheumatic heart disease, bacterial endocarditis, aortic valve stenosis, hypertension, coronary heart disease, including acute myocardial infarction, degenerative disease of the valves, connective tissue diseases, chest trauma, systemic lupus erythematosus, con-genital heart disease which leading to the mitral valve chords rupture, gives the current classification of the nosology and also features of manifestation and clinical cours

Arrhythmic risk in elderly patients candidates to transcatheter aortic valve replacement. predicative role of repolarization temporal dispersion

Degenerative aortic valve stenosis (AS) is associated to ventricular arrhythmias and sudden cardiac death, as well as mental stress in specific patients. In such a context, substrate, autonomic imbalance as well as repolarization dispersion abnormalities play an undoubted role. Aim of the study was to evaluate the increase of premature ventricular contractions (PVC) and complex ventricular arrhythmias during mental stress in elderly patients candidate to the transcatheter aortic valve replacement (TAVR). In eighty-one elderly patients with AS we calculated several short-period RRand QT-derived variables at rest, during controlled breathing and during mild mental stress, the latter being represented by a mini-mental state evaluation (MMSE). All the myocardial repolarization dispersion markers worsened during mental stress (p < 0.05). Furthermore, during MMSE, low frequency component of the RR variability increased significantly both as absolute power (LFRR) and normalized units (LFRRNU) (p < 0.05) as well as the low-high frequency ratio (LFRR/HFRR) (p < 0.05). Eventually, twenty-four (30%) and twelve (15%) patients increased significantly PVC and, respectively, complex ventricular arrhythmias during the MMSE administration. At multivariate logistic regression analysis, the standard deviation of QTend (QTesd), obtained at rest, was predictive of increased PVC (odd ratio: 1.54, 95% CI 1.14–2.08; p = 0.005) and complex ventricular arrhythmias (odd ratio: 2.31, 95% CI 1.40–3.83; p = 0.001) during MMSE. The QTesd showed the widest sensitive-specificity area under the curve for the increase of PVC (AUC: 0.699, 95% CI: 0.576–0.822, p < 0.05) and complex ventricular arrhythmias (AUC: 0.801, 95% CI: 0.648–0.954, p < 0.05). In elderly with AS ventricular arrhythmias worsened during a simple cognitive assessment, this events being a possible further burden on the outcome of TAVR. QTesd might be useful to identify those patients with the highest risk of ventricular arrhythmias. Whether the TAVR could led to a QTesd reduction and, hence, to a reductionof thearrhythmicburdenin thissettingofpatients isworthytobe investigated

Possible predicative role of electrical risk score on transcatheter aortic valve replacement outcomes in older patients. preliminary data

Background:Transcatheter aortic valve replacement (TAVR) is an effective procedure capable to change the natural history of the degenerative aortic valve stenosis. Despite the TAVR, the patients with advanced valve disease and severe myocardial damage (low flow, gradient and ejection fraction)show high mortality level. Aim of this study was toevaluate the predicative power of a noninvasive and inexpensive test obtained by means of a simple standard 12-leads electrocardiogram,known as the Electrical Risk Score (ERS). Methods: ERS was composed by seven simple ECG markers: heart rate (>75 bpm); QRS duration (>110 ms), left ventricular hypertrophy (Sokolow-Lyon criteria), delayed QRS transition zone (≥ V4), frontal QRS-T angle (>90°), long QTBazett (>450 ms for men and >460 in women) or JTBazett(330 ms for men and > 340 ms for women);long T peak to T end interval (Tp-e)( >89 ms). An ERS ≥ 4was considered high risk for all-cause or cardiovascular mortality.We calculated retrospectively the pre-procedure ERS in 40 TAVR patients after one year of follow-up. Results: In the follow up the all-cause and cardiovascular mortality were respectively 25% and 15%.None of survivors reported ERS ≥ 4,moreover, the ERS was the strongest predictor of all-cause (odd ratio 3.73, 95% CI: 1.44-9.66, p<0.05) or cardiovascular (odd ratio 3.95, 95% CI: 1.09-14.27, p<0.05) mortality.ROC curves showed that ERS had the widest significant sensitivity-specificity area under the curve (auc) predicting all-cause (auc: 0.855, p<0.05) or cardiovascular mortality (auc: 0.908, p<0.05). Conclusions:In this pivotal study, ERS resulted an useful tool to stratify the risk of mortality in one-year follow-up TAVR patients. Obviously, it is necessary to confirm these data in large prospective studies